Study Evaluating Treatment of Upper Limb Spasticity Using the Cryo-Touch III Device

Spasticity, common in neurological disorders, is part of the upper motor neuron syndrome
displaying increased tone, clonus, spasms, spastic dystonia and co- contractions. The impact
of spasticity on the patient varies from a subtle neurological sign to severe spasticity
causing pain and contractures. Upper limb spasticity (ULS) is the rapid contraction or
shortening of the muscles in the arm causing abnormal muscle movements in the elbow, wrist
and fingers. It has been reported that over 1 million Americans with traumatic injury to the
brain or spinal cord, stroke, multiple sclerosis and cerebral palsy experience ULS. Tightly
clenched fists, twisted wrist and elbow joints, and fixed arms in flexed positions result in
extreme discomfort, pain and spasm. A nonsurgical, minimally invasive, effective approach to
pain associated with ULS is desirable.

Myoscience, Inc. (Redwood City, CA) has developed a pain management device - the Cryo-Touch
III - for a novel, minimally invasive procedure using focused cold therapy to target sensory
nerve tissue and offer long-lasting pain relief through cryoanalgesia. The device operates
on the well-established cryobiology principle that localized exposure to controlled,
moderately low temperature conditions can alter tissue function. The therapy treats nerves
via a probe in the form of an assembly of small diameter needles, creating a highly
localized, low temperature treatment zone around the probe. This focused cold therapy
creates a conduction block that prevents nerve signaling. Prior studies of the Cryo-Touch,
Cryo-Touch II, Cryo-Touch III (a.k.a. PCP 1.0) devices have provided preliminary evidence of
effectiveness on motor nerves and have been shown to be safe with no serious device-related
adverse events.

Inclusion Criteria:

1. Male or female, 18 years of age and older.

2. Trial participants must have a confirmed diagnosis that results in spasticity
involving muscle innervated by the musculocutaneous nerve (MCN).

3. Any medications must be maintained on a stable schedule for at least two weeks prior
to treatment. No washout period is allowed.

4. Must have an average score on the Modified Ashworth Scale for Spasticity of ≥ 2 over
the last 30 days in the elbow.

5. Subject, in the Investigator's opinion, will not be exposed to unacceptable risk by
participation.

Exclusion Criteria:

1. Previous surgical intervention that altered the target neural anatomy of the upper
limb.

2. Any injection (neurolytic, sclerosing, anesthetic, etc.) to the upper limb within the
last 4 months.

3. Current enrollment in an investigational drug or device study that specifically
targets spasticity management.

4. Allergy or intolerance to local anesthesia.

5. Any local skin condition at the treatment site that in the investigator's opinion
would adversely affect treatment or outcomes.

6. Any chronic medication use (prescription, over-the-counter, etc.) that in the
investigator's opinion would affect study participation or subject safety.

7. Diagnosis of cryoglobulinemia, paroxysmal cold hemoglobinuria, cold urticaria,
Raynaud's disease, open and/or infected wounds.

8. Diagnosis of progressive neurologic diseases such as ALS.

9. For any reason, in the opinion of the investigator, the subject may not be a suitable
candidate for study participation (i.e., history of noncompliance, drug dependency,
any related upper limb injury, etc.).